Neural signatures of Trail Making Test performance: Evidence from lesion-mapping and neuroimaging studies

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The Trail Making Test (TMT) is an extensively used neuropsychological instrument for the assessment of set-switching ability across a wide range of neurological conditions. However, the exact nature of the cognitive processes and associated brain regions contributing to the performance on the TMT remains unclear. In this review, we first introduce the TMT by discussing its administration and scoring approaches. We then examine converging evidence and divergent findings concerning the brain regions related to TMT performance, as identified by lesion-symptom mapping studies conducted in brain-injured patients and functional magnetic resonance imaging studies conducted in healthy participants. After addressing factors that may account for the heterogeneity in the brain regions reported by these studies, we identify future research endeavours that may permit disentangling the different processes contributing to TMT performance and relating them to specific brain circuits.HIGHLIGHTSThe neural underpinnings of trail making test (TMT) performance remain unclear.We reviewed empirical evidence from healthy and brain-injured individuals.Regions in prefrontal and parietal cortex were found to mediate various TMT indices.There was a large variability in the brain regions reported across the studies.We suggest potential research avenues to unravel the neuroanatomy of the TMT.

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